Stress reliever

Saturday, March 27, 2010

DIY

Suddenly I feel pretty masculine.And no, it's got nothing to do with the male gonads.No, I went out and bought myself some power tools. And no, I'm not even talking about the shopvac, or the electric screwdriver.

No sir, I got me a circular saw, a reciprocating saw and an impact driver. We figured we've neglected to spruce up our home long enough, and planned some bigger projects this year. In part because of the baby, and in part because we know we'll have her and my families here and we want them comfortable.And so, I spent 4 hours last night just sawing and taking things apart, and then putting them back together. It's a wonder I still had my fingers to do my biopsies this morning. I caught myself wondering if we should have bought the disability insurance/income protection plan the broker was trying to sell us; I had images of the saw kicking back and slicing off my precious nose-pickers.But no, things worked out; with a lot of sweat, and a lot of KNNCCB cussing (thank goodness the dogs don't understand Hokkien) I got my projects done.And to think 2 days ago I refurbished our dresser with two layers of stain followed by another 2 of a polyurethane coating.

Sunday, March 21, 2010

Satisfaction is:Seeing your 28 year old patient with type 1 diabetes who initially came to you with an A1c of 14% and pregnant drop it to 6.4% and deliver a healthy baby boy.

This is one of the perks of this job. Sometimes, all you need is a motivated patient + some knowledge and you get a little miracle.

I was pretty worried when I first saw Ms. F at 14 weeks gestation. But she realized how high a risk this was to her, and to her baby, and took reign of her health. It was a coincidence that she went into labor during my call week. When I went in to see her postpartum, her husband picked me up in a bearhug and I hugged him back. The baby, truly, is perfect. A gorgeous bundle of joy, and her reward for her hard work.

Thursday, March 18, 2010

Doctor Shopping

(CNN) -- New in town, Brandy Preston reasoned that it was only lunch. She liked the fact that there were no strings attached. If she didn't like the person, she could just say, "It was nice to meet you," and leave.

"I was surprised because it felt so comfortable and I wasn't afraid to ask questions," the 29-year-old said. "I mean, I'd finally met the right match."This gynecologist was exactly who I wanted."

Call it speed dating for doctors. Texas Health Harris Methodist Hospital, near Fort Worth, has launched a program called Doc Shop that invites prospective patients to casually meet and size up a lot of doctors in a short amount of time.

I thought this was an interesting concept. I read it on CNN a week ago. Obviously it has its flaws, but the idea was fascinating to me. And I think on many levels, it makes sense. Finding a doctor is like finding a life partner. It's not just about credentials, qualifications, publications. It's not about where he works, whether he's in network, his waiting list and availability. It's also a relationship. And like all relationships, it's about personalities and compatibilities. And the truth is, because we're all different individuals, there will be some doctors we like, and some we don't. Some personalities are better suited to some, and not others.

I caught myself thinking about my doctor-persona. I know I've had some people who didn't want to come back to see me. Thankfully, the majority of my patients and I get along supremely well. They know humor is a big part of my life and I joke incessantly. My patients who know me, know I mean it endearingly when I refer to them as 'trouble'. Uh-oh, here comes trouble, I'd say, and the old guys would just snigger because they know I know they just came from the McDonald's downstairs. On hospital rounds, I'd ask the wives of the patients if they wanted us to keep them in the hospital for another week, to get them off their hands. They always have that tempted look.

They also know my views on the scope and responsibility as a doctor. I say I'm not here to tell them what to do; my job is to provide enough information for them to make the right choices. I make it no secret that I hope they'll pick the right choice for their health but in the end, it's really up to them. And they know I don't like to bullshit; if I don't know I'll just flat out say it. Why they're gaining weight? Dunno. Why is their skin dry? Beats me. Why are they losing hair? Look bud, if I knew the answer...

(and I'm not sure why physicians think these are all hormonal disorders).

I get along swell with most of them. I'm sure there are those who prefer a different kind of doctor and there are those who won't like how I work, and I don't take it personally (I try not to, anyway). I'm reminded of the all-knowing, emeritus-type Dr. S, who was considered a God in his field. He does not explain, does not give choices- he just tells patients what they're doing wrong and what needs to be done. And while I've seen him make some patients cry, many a patients remain loyal to him. As one patient once told me, "Doc, I don't want to know. You're the smart one (my wife would disagree) so you just pick the right treatment for me."

And so, I do think finding a doctor is also about finding a person whose personality matches yours. It's one thing we don't think about, beyond making sure this doctor is qualified and not some serial killer/quack/psycho, whether this doctor as a person, is right for me?

Monday, March 15, 2010

I saw Chris back for her diabetes follow up today. In my last 2 years here, I have gotten to know her pretty well and have come to appreciate her sense of humor. She also happens to live hear us, and we owe her for actually bringing our dog home when Chloe ran away that one time.

I have also gotten pretty used to her antics. Inevitably, she comes in with minimal glucose readings, one or two, every couple of days and certainly inadequate to provide trends, instead of the 3-4 daily for a patient on a 4-shot a day program. Her a1c remains poorly controlled. She asked me today: "What about an insulin pump?"

Now, I happen to love the insulin pump. If I had type 1 diabetes, that would be my way to go. But I get asked this a lot, and certainly get frequent referrals for this too.

"Patient with poorly controlled diabetes, refer for insulin pump.."

I share with Chris what the research has shown. It's a nifty device that may help with hypoglycemia, and with pregnant patients with diabetes (I just wish the dang companies weren't making so much money from my poor patients!). But the main advantage of the pump is that it provides more lifestyle flexibility to the patient in terms of insulin administration. It is NOT meant to bring now the A1c. In fact, a recent metaanalysis comparing SQ insulin to the pump showed only a 0.2% A1c lowering in a type 1 population, and virtually no A1c benefit in a type 2 (in fact the trend was that it got worse). In other words, if a patient isn't controlled with the shots, don't expect it to happen on a pump. Obviously, a metaanalysis is a composite of many studies and is very sound statistically, but every patient is different. But that's what the research shows. And it makes sense; the pump requires data for it to adequately do its job. Without periodic glucose results it's flying blind. It's a pain in the butt checking so frequently and counting one's intake so meticulously, but the rewards are real and for most, worth it; but only a patient can decide what's worth the trouble, never the doctor on the patient's behalf.

And so I tell her, if she isn't able to be more regular with her checks and insulins, it is very unlikely the pump will give her better results. Conversely, I have had many worsen their A1c readings because many actually stop checking completely when they get on a pump, thinking that it is all 'cruise control' now. So I left it to her to ponder. If she wants to give it a try, she could but unless she changes her ways, her A1c will likely remain high. She's a very intelligent adult, and is a very caring mother and so eventually she will have to make her choices.

Monday, March 08, 2010

Walk to Cure Diabetes

As an endocrinologist, although my main interest is thyroid disease, our bread and butter is diabetes. But truthfully, if there a cure for type 1 diabetes, even if that would give me far less business, I would wish for it for my patients with all my heart. It's a life-changing disease, that requires deep awareness of what one is eating, physical activity and its effects on the blood sugars. It is an absolute pain to manage, from the need to check glucose levels at least 4 times a day, to carb counting, and adjusting insulin doses to goal. As such, I truly have the utmost respect and admiration for my patients who do it so well.

This year, I'll be walking to raise fundsfor the Juvenile Diabetes Research Foundation. It's been a couple of years since I did a fundraiser(I did the 32-mile Tour de Cure ride not too long ago) so I thought it was about time, since I didn't feel like I was particularly helpful to many of my patients as a doctor.

So, if you have a couple of bucks to spare, and you want to put it to good use and want to get a lazy, tubby endocrinologist to move his butt, please consider donating to my cause. $200 gets you a topless picture of mua. If you want the pants off (vitals covered, of course), you'll need to get up $400! (just try to hold the puke in).

Thursday, March 04, 2010

What, you may ask, might an endocrinologist keep in his desk at work? Research papers? Medical books? Equipment, perhaps? I thought it was funny when I pulled open my drawer and the medical student beside me just looked flabbergasted. I guess I should practice what I preach, huh?

About Me

A Malaysian endocrinologist, trained in a major academic center in USA, and now surviving in the world of practice after 12 years of training.
To maintain patient confidentiality, names, ages and genders have been altered (And some stories totally fabricated to fool gullible readers).
This site is not meant to provide medical advice or consultation.